value: cdc-opioid-guidance

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

display: ECA Rule

// Subroutine 2 - Past Medications
define "Can the implementing EHR support queries for past medications by date range?":
  true

define "Active Ambulatory Opioid Rx":
    if Config."Can the implementing EHR support queries for past medications by date range?" then
      (
        "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest]))
      ) Rx
        where date from Rx.authoredOn 2 years or less on or before Today()
          and Rx.medication in "Opioid analgesics with ambulatory misuse potential"
    else
        List<FHIR.MedicationRequest>{}

define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  Common."Active Ambulatory Opioid Rx" AmbulatoryOpioidPrescription
    where Routines."Is Subacute or Chronic Pain Prescription?"(AmbulatoryOpioidPrescription)

define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists ("Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions")

// CDC 2022 General Inclusion Criteria
define "Age Less than 18 Years Is Enabled":
  true

define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else false

// Sickle Cell
define "Sickle Cell Check Enabled":
  true

define "Sickle Cell Assumed Active":
  true

// 3. Medications indicating end of life
    /* or exists (
      "Medications Indicating End of Life"
    ) */

define "US Core-Categorized Conditions":
  [Condition: category in "Encounter Diagnosis Condition Category"]
    union [Condition: category in "Problem List Condition Category"]
    union [Condition: category in "US Core Health Concern Condition Category"]

define "Positive Sickle Cell Condition":
  if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active"
    then (
      "US Core-Categorized Conditions" C
        where C.code in "Sickle Cell Diseases"
          and C.clinicalStatus in "Active Condition"
    ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active"
        then (
          "US Core-Categorized Conditions" C
            where C.code in "Sickle Cell Diseases"
        )
      else null

define "Condition Positive for Sickle Cell":
  if (Config."Sickle Cell Check Enabled") then
    exists(
      Common."Positive Sickle Cell Condition"
    ) 
  else false

// Active Cancer Treatment
define "Active Cancer Treatment Encounters Condition Is Enabled":
  true

// End of Opioid Naive Routine

/*
**  Routine #3
**  Active Cancer Treatment Routine
**
**  Definition                    | Answer to Proceed   | Details                                    | Data (Terminology) Requirement
**  ---------------------------------------------------------------------------------------------------------------------------------
**  Two office visits within the  | No                  | Look for a minimum of two distinct         | Office Visit
**  past 12 months                |                     | encounters within 12 months of the date    |
**                                |                     | of the current visit for which each of the |
**                                |                     | following is true:                         |
**                                |                     |   - the encounter diagnosis (primary or    |
**                                |                     |     secondary or co-morbidity diagnosis)   |
**                                |                     |     is listed in the CDC Malignant Cancer  |
**                                |                     |     Conditions value set                   |
**  ---------------------------------------------------------------------------------------------------------------------------------
**  Office visits with an         | No                  | The encounter is performed by an           | Oncology specialty
**  oncology specialist           |                     | oncologist as defined in the oncology      | designations (NUCC)
**  present                       |                     | specialty designations using the           |
**                                |                     | National Uniform Claim Committee           |
**                                |                     | (NUCC) classifications                     |
**  ---------------------------------------------------------------------------------------------------------------------------------
**  Office visits including CDC   | No                  | The encounter diagnosis (primary or        | CDC malignant cancer
**  malignant cancer              |                     | secondary or co-morbidity diagnosis)       | conditions
**  condition                     |                     | is listed in the CDC Malignant Cancer      |
**                                |                     | Conditions value set                       |
**  ----------------------------------------------------------------------------------------------------------------------------------
**
*/

define "Encounter Period":
  Interval[Today() - 12 months, Today())

define "USCore Encounter Cancer Diagnoses":
  [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses
    where CancerDiagnoses.code in "CDC malignant cancer conditions"

// encounter-diagnosis, problem-list and health-concern Conditions
// define "US Core-Categorized Cancer Diagnoses":
//   Common."US Core-Categorized Conditions" C
//     where C.code in Common."CDC malignant cancer conditions"

// define "Encounters with Cancer Diagnosis During Encounter Period":
//   [Encounter] Encounter
//     with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis
//     such that date from Encounter.period."start".value in day of "Encounter Period"
//       and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)

define "Encounters with Cancer Diagnosis During Encounter Period":
  [Encounter] Encounters
    where date from Encounters.period."start" in day of "Encounter Period"
      and exists (
        Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses
          where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)
      )

define "Number of Encounters with Cancer Diagnosis During Encounter Period":
  Count ("Encounters with Cancer Diagnosis During Encounter Period")

define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period":
  "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2

define "USCore Problem List Cancer Diagnoses":
  [Condition: category in "Problem List Condition Category"] CancerDiagnoses
    where CancerDiagnoses.code in "CDC malignant cancer conditions"

define "Has Active Cancer Diagnosis on Problem List":
  exists (
    Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses
      where CancerDiagnoses.category in Common."Problem List Condition Category"
        and exists(
          CancerDiagnoses.clinicalStatus.coding ClinicalStatus
            where ClinicalStatus.code ~ 'active'
        )
  )

define "Is Active Cancer Treatment?":
  if (Config."Active Cancer Treatment Encounters Condition Is Enabled") 
    then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
      or "Has Active Cancer Diagnosis on Problem List"
  else false

// CDC 2022 General Inclusion Criteria
define "End-Stage Disease Criteria Enabled":
  true

define "Conditions Likely Terminal for Opioid Prescribing":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          // and EOLC.clinicalStatus in Common."Active Condition"
    )
  else false

define "CDC 2022 Guideline General Inclusion Criteria":
  not "Patient Age Less Than 18"
    and not "Condition Positive for Sickle Cell"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Likely Terminal for Opioid Prescribing"

define "Use Alternative UDS Lookback Period":
  false

define "Alternative UDS Lookback Period":
  Interval[Today() - 6 months - 1 days, Today()]

define "All Opioid or Non-opioid UDS in Alternative Lookback Period":
  (
    [Observation: Common."All Drug Urine Screening"] Lab
      where date from Lab.effective in day of Config."Alternative UDS Lookback Period"
        and not (
          Lab.status in { 'unknown', 'entered-in-error', 'cancelled' }
        )
  ) X sort by date from effective desc

// Constants

define "UDS Lookback Period":
  Interval[Today() - 12 months - 1 days, Today()]

define "All Opioid or Non-opioid UDS in Lookback Period":
  (
    [Observation: Common."All Drug Urine Screening"] Lab
      where date from Lab.effective in day of "UDS Lookback Period"
        and not (
          Lab.status in { 'unknown', 'entered-in-error', 'cancelled' }
        )
  ) X sort by date from effective desc

/*
@description: Determines whether the general inclusion criteria is met for the patient and whether they had a UDS performed in the past year
*/
define "Inclusion Criteria For UDS Recommendation":
  Routines."CDC 2022 Guideline General Inclusion Criteria"
    and not exists (
      if Config."Use Alternative UDS Lookback Period"
        then "All Opioid or Non-opioid UDS in Alternative Lookback Period"
      else "All Opioid or Non-opioid UDS in Lookback Period"
    )

define "Conditions Indicating End of Life or With Limited Life Expectancy":
  (
    "US Core-Categorized Conditions" C
      where C.code in "Conditions likely terminal for opioid prescribing"
        and C.clinicalStatus in "Active Condition"
  )
  union
  (
    "US Core-Categorized Conditions" C
      where C.code in "Limited life expectancy conditions"
        and C.clinicalStatus in "Active Condition"
  )

// OpioidCDSCommon
define "Hospice Findings Exclusion Enabled":
  false

define "Admitted/Referred/Discharged to Hospice Care":
  (
    if (Config."Hospice Findings Exclusion Enabled") then
      [Observation: code in "Hospice Finding Codes"] O
        where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
    else
      {}
  )
  union
  (
    [Encounter] E
      where date from E.period.start 1 year or less on or before Today()
        and (
          if E.hospitalization.dischargeDisposition.coding is null
              or not exists (E.hospitalization.dischargeDisposition.coding)
            then false
          else E.hospitalization.dischargeDisposition in "Hospice Disposition"
        )
        and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
  )

define "End of Life Assessment":
    // 1. Conditions indicating end of life or with limited life expectancy
    exists (
      "Conditions Indicating End of Life or With Limited Life Expectancy"
    )
    // 2. Admitted/referred/discharged to hospice care
    or exists (
      "Admitted/Referred/Discharged to Hospice Care"
    )

define "Exclusion Criteria":
  Common."End of Life Assessment"

define "Is Perform Drug Screen Recommendation Applicable?":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Rec10Common."Inclusion Criteria For UDS Recommendation"
    and not Rec10Common."Exclusion Criteria"

define "Amphetamine Simple Identifier": 'Amphetamine'

// Amphetamines
define "Amphetamine Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Amphetamine Urine Tests"

define "Positive Amphetamine Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true)

define "Negative Amphetamine Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true)

define "Rx Lookback Period":
  Interval[Today() - 12 months - 31 days, Today()]

define "Normalize Rx In Lookback Period":
  Common."Get MedicationRequest Medication as Code"(
    [MedicationRequest: category in Common."Community"] Rx
      where Rx.status in { 'active', 'completed', 'stopped' }
        and Rx.intent = 'order'
        and Common."GetDateFromMedicationRequest"(Rx) in day of "Rx Lookback Period"
  )

define "Amphetamine Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
      where Rx.medication in Common."Amphetamine Medications"

define "Barbiturate Simple Identifier": 'Barbiturate'

// Barbiturates
define "Barbiturate Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Barbiturate Urine Tests"

define "Positive Barbiturate Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true)

define "Negative Barbiturate Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true)

define "Barbiturate Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
      where Rx.medication in Common."Barbiturate Medications"

define "Benzodiazepine Simple Identifier": 'Benzodiazepine'

// Benzodiazepines
define "Benzodiazepine Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Benzodiazepine Urine Tests"

define "Positive Benzodiazepine Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true)

define "Negative Benzodiazepine Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true)

define "Benzodiazepine Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
    where Rx.medication in Common."Benzodiazepine medications"

define "Buprenorphine Simple Identifier": 'Buprenorphine'

// Buprenorphine
define "Buprenorphine Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Buprenorphine Urine Tests"

define "Positive Buprenorphine Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true)

define "Negative Buprenorphine Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true)

define "Buprenorphine Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
    where Rx.medication in Common."Buprenorphine Medications"

define "Cannabinoid Simple Identifier": 'Cannabinoid'

define "Cannabinoid Urine Screening Check Enabled":
  false

// Cannabinoids
define "Cannabinoid Screenings In Lookback Period":
  if Config."Cannabinoid Urine Screening Check Enabled"
    then (
      "All Opioid or Non-opioid UDS in Lookback Period" Lab
        where Lab.code in Common."Cannabinoid Urine Tests"
    ) else null

define "Positive Cannabinoid Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled")

define "Negative Cannabinoid Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled")

define "Cocaine Simple Identifier": 'Cocaine'

// Cocaine
define "Cocaine Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Cocaine Urine Tests"

define "Positive Cocaine Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true)

define "Negative Cocaine Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true)

define "Fentanyl Simple Identifier": 'Fentanyl'

// Recommendation 10
define "Opiate Urine Screening Check Enabled":
  true

// Fentanyl
define "Fentanyl Screenings In Lookback Period":
  if Config."Opiate Urine Screening Check Enabled"
  then (
    "All Opioid or Non-opioid UDS in Lookback Period" AllLabs
      where AllLabs.code in Common."Fentanyl Urine Tests"
  ) else null

define "Positive Fentanyl Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")

define "Negative Fentanyl Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")

define "Fentanyl Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
    where Rx.medication in Common."Fentanyl Medications"

define "Heroin Simple Identifier": 'Heroin (6-AM)'

// Heroin
define "Heroin Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Heroin Urine Tests"

define "Positive Heroin Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true)

define "Negative Heroin Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true)

define "Methadone Simple Identifier": 'Methadone'

// Methadone
define "Methadone Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" Lab
    where Lab.code in Common."Methadone Urine Tests"

define "Positive Methadone Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true)

define "Negative Methadone Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true)

define "Methadone Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
    where Rx.medication in Common."Methadone Medications"

define "Opiate Simple Identifier": 'Opiate'

// Opiates
define "Opiate Screenings In Lookback Period":
  if Config."Opiate Urine Screening Check Enabled"
    then (
      "All Opioid or Non-opioid UDS in Lookback Period" Lab
        where Lab.code in Common."General Opiate Urine Tests"
    ) else null

define "Positive Opiate Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")

define "Negative Opiate Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")

define "Opiate Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
    where Rx.medication in Common."Opiate Medications"

define "Oxycodone Simple Identifier": 'Oxycodone'

// Oxycodone
define "Oxycodone Screenings In Lookback Period":
  if Config."Opiate Urine Screening Check Enabled"
    then (
      "All Opioid or Non-opioid UDS in Lookback Period" Lab
        where Lab.code in Common."Oxycodone Urine Tests"
    ) else null

define "Positive Oxycodone Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")

define "Negative Oxycodone Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")

define "Oxycodone Rx In Lookback Period":
  "Normalize Rx In Lookback Period" Rx
    where Rx.medication in Common."Oxycodone Medications"

define "PCP Simple Identifier": 'Phencyclidine (PCP)'

// PCP
define "PCP Screenings In Lookback Period":
  "All Opioid or Non-opioid UDS in Lookback Period" AllLabs
    where AllLabs.code in Common."PCP Urine Tests"

define "Positive PCP Screenings In Lookback Period":
  GetPositiveLabsInLookbackPeriod("PCP Screenings In Lookback Period", true)

define "Negative PCP Screenings In Lookback Period":
  GetNegativeLabsInLookbackPeriod("PCP Screenings In Lookback Period", true)

// Details Logic

define "Unexpected Details":
  {
    CreateDetailWithPossibleUnexpectedNegative(
      "Amphetamine Simple Identifier", "Positive Amphetamine Screenings In Lookback Period", 
      "Negative Amphetamine Screenings In Lookback Period", "Amphetamine Rx In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Barbiturate Simple Identifier", "Positive Barbiturate Screenings In Lookback Period", 
      "Negative Barbiturate Screenings In Lookback Period", "Barbiturate Rx In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Benzodiazepine Simple Identifier", "Positive Benzodiazepine Screenings In Lookback Period", 
      "Negative Benzodiazepine Screenings In Lookback Period", "Benzodiazepine Rx In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Buprenorphine Simple Identifier", "Positive Buprenorphine Screenings In Lookback Period", 
      "Negative Buprenorphine Screenings In Lookback Period", "Buprenorphine Rx In Lookback Period"
    ),
    CreateDetailWithoutPossibleUnexpectedNegative(
      "Cannabinoid Simple Identifier", "Positive Cannabinoid Screenings In Lookback Period", 
      "Negative Cannabinoid Screenings In Lookback Period"
    ),
    CreateDetailWithoutPossibleUnexpectedNegative(
      "Cocaine Simple Identifier", "Positive Cocaine Screenings In Lookback Period", 
      "Negative Cocaine Screenings In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Fentanyl Simple Identifier", "Positive Fentanyl Screenings In Lookback Period", 
      "Negative Fentanyl Screenings In Lookback Period", "Fentanyl Rx In Lookback Period"
    ),
    CreateDetailWithoutPossibleUnexpectedNegative(
      "Heroin Simple Identifier", "Positive Heroin Screenings In Lookback Period", 
      "Negative Heroin Screenings In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Methadone Simple Identifier", "Positive Methadone Screenings In Lookback Period", 
      "Negative Methadone Screenings In Lookback Period", "Methadone Rx In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Opiate Simple Identifier", "Positive Opiate Screenings In Lookback Period", 
      "Negative Opiate Screenings In Lookback Period", "Opiate Rx In Lookback Period"
    ),
    CreateDetailWithPossibleUnexpectedNegative(
      "Oxycodone Simple Identifier", "Positive Oxycodone Screenings In Lookback Period", 
      "Negative Oxycodone Screenings In Lookback Period", "Oxycodone Rx In Lookback Period"
    ),
    CreateDetailWithoutPossibleUnexpectedNegative(
      "PCP Simple Identifier", "Positive PCP Screenings In Lookback Period", 
      "Negative PCP Screenings In Lookback Period"
    )
  }

define "Remove Substances Without Positive or Negative Results":
  "Unexpected Details" Details
    where (Details.posDates is not null and Length(Details.posDates) != 0)
      or (Details.negDates is not null and Length(Details.negDates) != 0)

define "Inclusion Criteria For Unexpected Results":
  Routines."CDC 2022 Guideline General Inclusion Criteria"
  and AnyTrue(
    "Remove Substances Without Positive or Negative Results" Details
      return (exists Details.unexpectedPosDetails) or (exists Details.unexpectedNegDetails)
  )

define "Applicable Because of Unexpected Results":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Rec10Common."Inclusion Criteria For Unexpected Results"
    and not Rec10Common."Exclusion Criteria"

define "Style Header":
  '<style>\r\n  .alert-body {\r\n    width: 670px;\r\n    font-family: segoe-ui, sans-serif;\r\n    background-color: #FEFFF1;\r\n  }\r\n\r\n  .details-table {\r\n    border-collapse:collapse;\r\n    border-style: ridge;\r\n    background-color: #FEFFF1;\r\n    padding: 2px;\r\n  }\r\n\r\n  .details-caption {\r\n    border-style: ridge;\r\n    border-bottom: none;\r\n    background-color: #FEFFF1;\r\n    padding: 2px;\r\n  }\r\n\r\n  .details-table-header {\r\n    border-style: ridge;\r\n    padding: 5px;\r\n  }\r\n\r\n  .details-table-cell {\r\n    border-style: ridge;\r\n    padding: 5px;\r\n  }\r\n\r\n  .details-table-footer-cell {\r\n    border-style: ridge;\r\n    padding: 5px;\r\n    font-size: small;\r\n  }\r\n\r\n  .details-table-cell-unexpected {\r\n    border-style: ridge;\r\n    padding: 5px;\r\n    color: red;\r\n    font-weight: bold;\r\n  }\r\n\r\n  .more-text {\r\n    position: relative;\r\n    margin-bottom: 2em;\r\n  }\r\n  \r\n  .more {\r\n    display:none;\r\n  }\r\n\r\n  .show-more:checked + .more {\r\n    display:block;\r\n  }\r\n<\/style>'

define "Unexpected Div Start":
  '<div class=\"alert-body\"><div><p>Patient may have <strong>unexpected urine toxicology test results<\/strong> in the past year.<\/p><\/div>'

define "Table Start":
  '<div><table class=\"details-table\"><caption class=\"details-caption\">Urine Toxicology Results<\/caption><tr><th class=\"details-table-header\">Substance<\/th>'

// Helpers  

define "All Lab Dates in Lookback Period":
  (
    "All Opioid or Non-opioid UDS in Lookback Period" Lab
      return date from Lab.effective
  ) X sort desc

define "Table Headers":
  "All Lab Dates in Lookback Period" LabDate
    return '<th class=\"details-table-header\">' & ToString(LabDate) & '<\/th>'

define "Generate Table Rows":
  "Remove Substances Without Positive or Negative Results" BOT
    let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1)
    return '<tr>' + GetExpectedColumn(BOT.ingredient) + Combine(
      "All Lab Dates in Lookback Period" LabDate
        let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2)
        return all (
          if BOT.unexpectedPosDetails.date contains LabDate
            then GetUnexpectedColumn('pos', row & ':' & col)
          else if BOT.unexpectedNegDetails.udsDate contains LabDate
            then GetUnexpectedColumn('neg', row & ':' & col)
          else if BOT.posDates contains LabDate
            then GetExpectedColumn('pos*')
          else if BOT.negDates contains LabDate
            then GetExpectedColumn('neg*')
          else GetExpectedColumn('n/a')
        )
    ) + '<\/tr>'

define "Generate Footer Rows":
  "Remove Substances Without Positive or Negative Results" BOT
      let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1),
      colspan: Length("All Lab Dates in Lookback Period") + 1
      return Combine(
          "All Lab Dates in Lookback Period" LabDate
            let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2)
            return all (
              if BOT.unexpectedPosDetails.date contains LabDate
                then Coalesce(
                  BOT.unexpectedPosDetails PosDetail
                    where PosDetail.date same day as LabDate
                      return '<tr>' & GetFooterColumn(colspan, row & ':' & col & ' - Possible unexpected substance found: ' & PosDetail.udsDetail) & '<\/tr>'
                )
              else if BOT.unexpectedNegDetails.udsDate contains LabDate
                then Coalesce(
                  BOT.unexpectedNegDetails NegDetail
                    where NegDetail.udsDate same day as LabDate
                      return '<tr>' & GetFooterColumn(colspan, row + ':' & col & ' - Possible unexpected negative result found: prescribed ' & NegDetail.rxDetail & ' on ' & ToString(NegDetail.rxDate)) & '<\/tr>'
                )
              else ''
            )
      )

define "Table End":
  '<\/table><\/div>'

define "Details Table": 
  "Table Start" & Combine("Table Headers") 
    & '<tbody>' & Combine("Generate Table Rows") & '</tbody>' 
    & '<tfoot>' & Combine("Generate Footer Rows") & '<\/tfoot>' 
  & "Table End"

define "Expected Result Footnote":
  '<div>* - These are expected results based on an analysis of the patient\'s medication list 30 days prior to the corresponding lab results.<\/div>'

define "Details More Info":
  '<div id=\"box\">\r\n  <p>Note on false positives and unexpected negative results...<\/p>\r\n  <input type=\"checkbox\" class=\"show-more\"> Show more\r\n  <div class=\"more\">\r\n  <p>An unexpectedly negative test may be due to time since last dose, diversion, intermittent use, aberrant drug use behavior, or other factors, including a false negative result. Clinicians should interpret this result in the context of the overall treatment plan.<\/p>\r\n\r\n  <p>Positive results may be a false positives or could represent occasional use or possible substance use disorder.<br\/><br\/>For a review regarding interpreting possible false positive urine toxicology results, see <a target=\"_blank\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24986836\">http:\/\/pubmed.ncbi.nlm.nih.gov\/24986836<\/a>. It is unknown if the findings reported in this article can be extrapolated to other laboratory analyzers that were not used in the referenced studies.<br\/><br\/>For guidance regarding evaluating and addressing unexpected toxicology tests results, see <a target=\"_blank\" href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/rr\/rr7103a1.htm#Recommendation10\">Recommendation 10 of the 22 CDC Clinical Practice Guideiline<\/a>.<\/p><\/div>\r\n<\/div>'

define "Div End": '<\/div>'

// HTML Generation

define "Get HTML Details":
  Common."Style Header" & "Unexpected Div Start" & "Details Table" & "Expected Result Footnote" & "Details More Info" & "Div End"

define "Detail":
  Rec10Common."Get HTML Details"

define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
  value Rx
    let Med: 
      if Rx.medication is Reference then singleton from (
        [Medication] M
          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
      ) else null
    return 
      MedicationRequest {
        id: Rx.id,
        status: Rx.status,
        intent: Rx.intent,
        category: Rx.category,
        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
        subject: Rx.subject,
        authoredOn: Rx.authoredOn,
        recorder: Rx.recorder,
        dosageInstruction: Rx.dosageInstruction,
        dispenseRequest: Rx.dispenseRequest
      }

define function ToString(value string): value.value

define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>:
  value Rx
    where Rx.status.value = 'active'
      and Rx.category in "Community"

define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

define function ToDateTime(value dateTime): value.value

// End of Active Cancer Treatment Routine

/*
**  Routine #4
**  For Subacute or Chronic Pain Routine
**
**  Definition                  | Answer to Proceed   | Details                                        | Data (Terminology) Requirement
**  -----------------------------------------------------------------------------------------------------------------------------------
**  Order for opioid analgesic  | Yes                 | Order for opioid analgesics with ambulatory    | Opioid analgesics with
**  with expected supply        |                     | misuse potential with a supply duration of >=  | ambulatory misuse potential
**  duration >= 28 days         |                     | 28 days                                        |
**                              |                     |                                                |
**                              |                     | - Subacute definition = order for opioid       |
**                              |                     |   analgesics with ambulatory misuse            |
**                              |                     |   potential with a supply duration of one to   |
**                              |                     |   two months.                                  |
**                              |                     | - Chronic pain definition = order for opioid   |
**                              |                     |   analgesics with ambulatory misuse            |
**                              |                     |   potential with a supply duration of >= two   |
**                              |                     |   months.                                      |
**  -----------------------------------------------------------------------------------------------------------------------------------
**
*/

define function "Is Subacute or Chronic Pain Prescription?"(prescription FHIR.MedicationRequest):
  "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription)
    or "Is Subacute or Chronic Pain Using Validity Period"(prescription)

define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest):
  (
    prescription.dispenseRequest is not null
      and prescription.dispenseRequest.expectedSupplyDuration is not null
      and (
        Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days 
      )
  )

define function GetDurationInDays(value FHIR.Duration):
  if value is null then null
  else
    case
      when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
      when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
      when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
      when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
      when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
      when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
      when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
      else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end

define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest):
  (
    prescription.dispenseRequest is not null
      and prescription.dispenseRequest.validityPeriod is not null
      and (
        days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 
      )
  )

define function ToDateTime(value instant): value.value

define function ToString(value ObservationStatus): value.value

define function CreateDetailWithPossibleUnexpectedNegative(TheSubstance String, ThePosLabs List<Observation>, TheNegLabs List<Observation>, TheMeds List<MedicationRequest>):
  {
    ingredient: TheSubstance,
    posDates: (
      ThePosLabs PosLab
        return date from PosLab.effective
    ),
    negDates: (
      TheNegLabs NegLab
        return date from NegLab.effective
    ),
    unexpectedPosDetails: (
      ThePosLabs PosLab
        where not exists (
          TheMeds Rx
            where Common.GetDateFromMedicationRequest(Rx)
              in day of Interval[
                date from PosLab.effective - 31 days,
                date from PosLab.effective - 1 days
              ]
        )
        return {
          date: date from PosLab.effective,
          udsDetail:
            if exists(PosLab.code.coding)
              then PosLab.code.coding[0].display
              else 'Unable to determine a detailed identifier'
        }
    ),
    unexpectedNegDetails: (
      from TheNegLabs NegLab,
        ( if exists(TheMeds) then TheMeds else { null as MedicationRequest } ) Rx
        let medDate: Common.GetDateFromMedicationRequest(Rx)
          where medDate in day of Interval[date from NegLab.effective - 31 days, date from NegLab.effective - 1 days]
          return {
            udsDate: date from NegLab.effective,
            udsDetail: if exists (NegLab.code.coding) then NegLab.code.coding[0].display else 'Unable to determine a detailed identifier',
            rxDate: medDate,
            rxDetail: 
              if Rx.medication.text is not null then Rx.medication.text
              else if exists (Rx.medication.coding) and Rx.medication.coding[0].display is not null then Rx.medication.coding[0].display 
              else 'Unable to determine a detailed identifier'
          }
    )
  }

define function "GetDateFromMedicationRequest"(med FHIR.MedicationRequest):
  if med is null then
    null
  else if med.authoredOn is not null then
    date from med.authoredOn
  else
    Max(
      med.dosageInstruction DI
        return Coalesce(
          // If there are timing events, take the latest.
          Max(DI.timing.event E return date from E),
          // Otherwise, if there's a Period, use its start.
          if DI.timing.repeat is not null
             and DI.timing.repeat.bounds is FHIR.Period
          then
            date from start of FHIRHelpers.ToInterval(DI.timing.repeat.bounds as FHIR.Period)
          else
            null
        )
    )

define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function GetPositiveLabsInLookbackPeriod(Labs List<FHIR.Observation>, Enabled Boolean):
  if Enabled
    then Labs Lab
     where StartsWith(Lower(Lab.value as FHIR.string), 'pos')
  else {}

define function GetNegativeLabsInLookbackPeriod(Labs List<FHIR.Observation>, Enabled Boolean):
  if Enabled
    then Labs Lab
     where StartsWith(Lower(Lab.value as FHIR.string), 'neg')
  else {}

define function ToString(value MedicationRequestStatus): value.value

define function ToString(value MedicationRequestIntent): value.value

define function CreateDetailWithoutPossibleUnexpectedNegative(TheSubstance String, ThePosLabs List<Observation>, TheNegLabs List<Observation>):
  {
    ingredient: TheSubstance,
    posDates: (
      ThePosLabs PosLab
        return date from PosLab.effective
    ),
    negDates: (
      TheNegLabs NegLab
        return date from NegLab.effective
    ),
    unexpectedPosDetails: (
      ThePosLabs PosLab
        return {
          date: date from PosLab.effective,
          udsDetail: if exists (PosLab.code.coding) then PosLab.code.coding[0].display else 'Unable to determine a detailed identifier'
        }
    ),
    unexpectedNegDetails: {
      null as Tuple{ udsDate System.Date, udsDetail System.String, rxDate System.Date, rxDetail System.String }
    }
  }

define function GetExpectedColumn(Content String):
  '<td class=\"details-table-cell\">' & Content & '<\/td>'

// Functions

define function GetUnexpectedColumn(Result String, Superscript String):
  '<td class=\"details-table-cell-unexpected\">' & Result & '<sup>' & Superscript & '<\/sup><\/td>'

define function GetFooterColumn(colspan Integer, message String):
  '<td class=\"details-table-cell\"' & ' colspan=' & ToString(colspan) & '>' & message & '<\/td>'

Documentation

• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain